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� �, <br /> .._ , , <br /> Scc.13.04 RIGIiTS OF SLTBJECTS OF D�TA <br /> Subd. 1. Type oC data. The righcs of individual on whom ehe data is stored or to be s�ored shaIl be as set forrh in this secdon. = <br /> Subd.2. Information reqiured to be givm indiridual. An individual uked to suppiy privare or confidenrial dara concerning himseif shall <br /> be iaformed oF. (a)the purpose and inc:aded use of the r�quesc�dara wichia the collecung State agency,poliacal subdivisioa,or sncewide rystem; <br /> (b)whaher he may re:use or is legally required to supply che requesud dau;(c)any lrnown coacequence arising from his supplying or refusing W supply <br /> privace or conndendal dara;u:d(d)che idendry of ocher persons or enriri:s authocizcd by sc�te or fedecal law to teceive the dara. This requ'irement shall . <br /> aoc appiy when an individual is asked to supply invesdgarive dam,parsuanc to secdon 13.83,subdivision S,to a law enforcemen�ofricer. • <br /> 'Iht eomr,eizsioner of revenue mav place the nocce r_ouir:d under this subdivision in the individual income taz or vrooertv tax cefuad <br /> instrucdons uucead of on those forms. <br /> Subd.3. Access to data by iadi�ldual. Upon requcst to a responsible auchoriry,aa individual shall be informed whether he is the subject � <br /> of smr_d daci on individuals,and whecher it is classifi:d as pubiic,privac�or conFdendal. Upon his furih:r request,an individual who is the subjecc <br /> of scored privatr or public daea on individuaIs shall be shown che data wichout any charge to tilm and;if he desires, shall be informed of the concent <br /> and meaniag of[hat daca. Afur an individual has been showa the priva�dara and informed of iu meaaing,the daca need not be disclosed to him for <br /> six monchs�hereafter uriless a dispute or acdon pursuant to�his secdon is pending or addidoaal daca on the individual has been collecmd or ereared. <br /> The r.sponsible au[horiry shall provide copies of the private or public data upon request by[he individual subjecc of the daa. The respansibie auchoriry <br /> may require the requesang person to pay the acnial cos[t of making,cerafying,and eomp�ing the copies. <br /> The responsible au�horiry shall compty immedia�ety,if possible,wich any request made pursuant to this subdivision,or wichin five days of <br /> the da�e of che request,ezciuding Sacurdays.Sundays and legal holidays,if immediate compliance is not possible. If he eannot comply with the requesc <br /> wirhin[hat cime,he shatl so inform[he individual,and may have an addidonal five days wicfiin which to comply wich the request,exciudiag Sanirdays, <br /> Sandays and legal hotidays. <br /> Subd.4. Procedure vrhen data is not accurate or complete. An individual may coatest the accuracy or compleceness of public orprivate <br /> dara conc:rning tiinself. To exercise chis rich4 an individua!shall noaty in wriang che respoasibic auchoriry describing the nature of�he disagreement <br /> The responsible authoriry shall wichin 30 days ei[her: (a)correct che daca found to be inaceurdte or incomple�e and actempt to noafy pasc recipiencs of <br /> inaccurace or incomplece daca, inciuding re:ipiena named by�he individu�i;or(b)noafy che individaal that he believes the dara to be eoaecc Data <br /> in dispute shalt be disc(osed only if che individual's setem�nc of disagreement is includtd wi�h�h:disdosed dan. <br /> The decerminadon of the responsible auchoriry may be appealed punuant to the provisions of the adminisaauve procedure act reladng to <br /> contested eases. <br /> DATA PRIVACY ADYISORY _ � , <br /> In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data",we would like to inform you that your request <br /> for a permic or license from the Ciry of Orono or any of ia departments may require you to fumish certain private or <br /> confidential informacion. " <br /> You are notified that:• <br /> 1. The information you furnish will be used to determine your qualification for the permit or license requested. <br /> 2. You may refuse to supply data, but refusal may require tha[ the City deny the permit or license. <br /> 3. The information may be shared with ocher local, state or federal agencies to the eztent necessary to process <br /> ' the permit or license. <br /> 4. If your requested permit or license requires Council actlbn to approve, some information maq become <br /> public. <br /> 5. You have certain rights under M.S. I3.04 (available upon request) to review private data on yourself. <br /> 6. Your full name is required to process this application or permi�. . • <br /> r-�lc� � � � ��- , . <br /> irst � � �fiddle Lasc <br /> r J� � �-�,�L�-�e.� (�-n�l� <br /> Aaa�(�ry('�r'�1��..f �� . ��n SS�_��7 ��-���i�7`7 <br /> Ciry Snte Zip Phone . . <br /> I understand y ri�hts as sta[ed above. . . ,, <br /> �, - <br /> Signature . <br />